title: Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy.
abstract: BACKGROUND
  The appropriate surgical stump closure after distal pancreatectomy (DP) is still controversial. This study investigated the benefits and risks of stapler closure during DP.
  
  
  METHODS
  The risk factors of pancreatic fistulas were investigated in 122 DPs among 3 types of stump closure: hand-sewn suture (n = 32), bipolar scissors (n = 45), and stapler closure (n = 45).
  
  
  RESULTS
  There was no significant difference in the incidence of pancreatic fistula between the 3 types of stump closure (hand-sewn suture [44%] vs bipolar scissors [37.7%] vs stapler closure [35.5%]). By using receiver operating characteristics curves, 12 mm was the best cutoff value of the thickness of the pancreas for pancreatic fistulas after DP using stapler closure. Three factors (ie, male sex, body mass index >25 kg/m(2), and stapler closure) were independent risk factors of pancreatic fistulas after DP with a pancreas thicker than 12 mm.
  
  
  CONCLUSIONS
  A pancreas thicker than 12 mm significantly increased the incidence of pancreatic fistulas after DP using stapler closure.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Okada
authors.forename: Seiko
authors.initials: S
authors.lastname: Hirono
authors.forename: Motoki
authors.initials: M
authors.lastname: Miyazawa
authors.forename: Astusi
authors.initials: A
authors.lastname: Shimizu
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kitahata
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology* / Q000601:surgery*; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D012372:ROC Curve; D012307:Risk Factors; D018709:Statistics, Nonparametric; D017792:Surgical Stapling / Q000009:adverse effects*; D013536:Suture Techniques
keywords: Distal pancreatectomy; Pancreatic fistula; Stapler closure